Given that Tech and especially UTMB claimed to have been losing money hand over fist BEFORE recent cuts to prisoner healthcare, I have a hard time imagining other universities seeking to get in on the deal without the Legislature forcing them to participate (which couldn't happen before 2013). Hell, UTMB would desperately like to get out of the deal, but the Legislature won't let them.
Another line from the story struck me as at best wishful thinking: "When the Legislature approved funding for prison health care in May, leaders said they were confident the amounts would be enough to cover all the costs — if prison and medical officials worked to make the system more efficient." That's not really accurate. Nobody was confident the new budget would cover all costs, they just hacked away at the budget with a machete without any formal assessment of whether or not constitutional levels of care could still be delivered under the new budget.
Indeed, they'd been told previously that at the old levels of funding prison healthcare was barely constitutional. When the cuts were finalized in May, Grits wrote that "As far back as 2005, UTMB officials said the system was near the brink of failing to provide constitutional levels of care: 'We can't go any farther,' said [Dr. Ben] Raimer, a physician and former chairman of the state's Correctional Managed Health Care Committee. 'I'm certainly not going to be involved with a system that is not constitutional. . . . We're at that line now. One step across it and we're there.' Unfortunately, the state since then has taken several more steps across that line, culminating in this year's outright draconian cuts."
The latest budget cuts coincide with another important change in how prison healthcare is structured, with TDCJ bureaucrats calling the shots now instead of the old Correctional Managed Health Care Committee. Wrote Ward:
The difficulties facing the prison health care system are even more pronounced because the Legislature changed the management structure this year, according to several officials familiar with the discussions but who asked not to be quoted by name because they are not authorized to speak publicly.Changing the management structure will do nothing to reduce costs and anyone claiming they were "confident" budgeted amounts will cover prison healthcare expenses is either a fool or a liar. Given inflation in the healthcare field and reported losses by UTMB and Tech in prior years, nobody in their right mind could possibly believe the Lege budgeted enough for this line item. One notices that confidence wasn't attributed to anybody willing to put their name on such a ridiculous statement.
Previously, the health care system was coordinated by the Correctional Managed Health Care Committee, created in 1993 to oversee care by UTMB and Tech. The idea was to have a committee with a majority of doctors who could focus on access to care and the quality of care, not prison officials or prison board members, who were not medical professionals.
Now, the Legislature has returned the management to the Texas Department of Criminal Justice, and prison officials are in charge. The committee is shrinking from nine to five members, and the prison board will sign and manage the contracts for care, instead of the committee.
On Friday, the prison board took the first step to take charge, approving a six-month extension of the contracts with UTMB and Texas Tech to allow for new contracts to be negotiated. UTMB and Texas Tech officials were not available for comment.
In the past year, both universities have downsized the hours and staffing at prison clinics to try to stay within the budget. But with drug costs and other expenses rising, they have been hard-pressed to keep up — triggering increasing complaints about slow access to care at many prisons.
At the end of the story, House Corrections Chairman Jerry Madden said, "While we think there are efficiencies that may be realized in the current system, we don't think they should reduce services below what is required. ... I'm sure if they need additional funding, they will come discuss it with us." Well, sir, they already came and discussed it with you: They told you what it would cost to run prison healthcare in TDCJ's Legislative Appropriations Request and y'all slashed it by nearly $130 million. Why would anyone think the Lege would provide "additional funding" anytime in the near future? And even if they ask for more money, the state is broke: Where would it possibly come from?
Texas prison healthcare costs were already among the lowest (per prisoner) in the nation, and the latest budget cut not just to the bone but through it. No matter what discussions happen behind the scenes between TDCJ and legislators (or for that matter, other medical schools), it's clear to me the Legislature is leading the agency down the same path that ultimately caused a federal court to order California to radically reduce its prison population because of inadequate healthcare. Like California, the Texas Lege wants to cut corrections spending but this session was politically incapable of taking the only action that could realistically achieve that goal: Reducing the number of prisoners incarcerated. So don't be surprised if, given the Legislature's inability to manage its business, sometime in the future the federal courts end up having to do it for them, just like in the Golden State.